Only a senior member of the Trauma Team who has undergone induction training can trigger Code Red Trauma.
Tranexamic acid
Tranexamic acid is an antifibrinolytic agent that inhibits activation of plasminogen to plasmin; a bolus of Tranexamic acid (2g, iv over 10 min) should have been started within 3 hours of injury. Check whether this has already been given pre-hospital.
Blood Transfusion
Emergency Group O Stock Group O Neg (use in females) and O Pos (use in males) blood available in blood track fridge for CODE RED use.
MUST INFORM Blood Bank when units used so that stocks can be replaced Switch from Group O to patient’s group as soon as possible.
CODE RED PACK A contains: 6 units RBC 6 units FFP.
CODE RED PACK B contains: 4 units FFP; 1 pool Platelets; and 1 pool cryoprecipitate.
Fresh Frozen Plasma
FFP needs defrosting before issue – this takes around 30mins (allow time for transit) Each dose should contain ~15ml/kg of FFP – around 4units for average adult.
Cryoprecipitate
Cryoprecipitate needs defrosting before issue – this takes around 30mins (plus allow for time transit) Do not put cryo in fridge after defrosting since can precipitate.
Each dose should contain 2 pools cryoprecipitate for average adult.
Platelets
Stored at ambient temperature DO NOT REFRIGERATE.
Since platelets have short shelf life of 5 days only the blood bank has limited supplies of platelets and has to order additional units from the Blood centre as needed.
Laboratory testing
Must request fibrinogen as well as coagulation screen and Full Blood count for all patients with massive haemorrhage.
Repeat testing of Coagulation screen including fibrinogen and platelet count needed after transfusion of components to guide further replacement. ROTEM testing is available to further guide you (see below).
Recombinant FVIIa
Discuss with Haemophilia Registrar (Bleep 1155 or via switchboard on call) regarding use of rFVIIa in patient who continues to bleed despite replacement therapy with FFP, platelets and cryoprecipitate
Simulated Code Red
Follow this link to a YouTube video of a simulated Code Red produced by the RLH Trauma Anaesthetic Group, directed by Billy English.
ROTEM_2023 ROTEM-in-Trauma-very-useful-readThis video above will help you to understand the use of ROTEM- use the password RoyalLondon2022@